TB in Decline Except for Northern Virginia

Across the state, the reported cases of active tuberculosis (TB) have been continuously going down. Nationally, in some parts of the country the disease has been virtually wiped out.

The downward spiral, however, has not continued in Fairfax County, where just the opposite is happening.

According to the Fairfax County Health Department Web site, in 2000, the most recent figures available, there were 89 new cases of tuberculosis in Fairfax County, which includes figures from the cities of Fairfax and Falls Church. The rate of new cases that year was 9.1 per 100,000 residents in the county while the statewide the rate was 4.2 per 100,000.

Since 1991, there has been at least 60 new cases reported in the county each year, with the largest jump coming in 1996 when 101 new cases were reported. The Web site attributes the jump to an improved reporting system. Since then, the figures for the county have steadily climbed from 73 cases to 89 two years ago.

"TB was just a part of everybody's life 30-40 years ago. It's been a part of human existence for more than 500 years," said Dr. Ram Koppaka, director of the division of tuberculosis control for the Virginia Department of Health. "While we're seeing the numbers for the state declining, the number of incidents in Northern Virginia has increased."

Even so, Koppaka said, it is clearly not an epidemic.

"Yes, TB is an important problem, but it's curable," Koppaka said.

IN 2000, the Centers for Disease Control and Prevention (CDC) reported 16,377 active cases of TB. That figure looks to have dropped to 15,989 cases according to preliminary numbers, said Jessica Frickey, CDC spokesperson. Frickey said Virginia ranks about 20 to 22 nationwide in new reports. She said about 10 million to 15 million people have the tuberculosis infection without showing signs of the disease. Those with the infection have breathed in the bacteria, but may not experience symptoms immediately. TB is not contagious while it is still in the infection stage. However, once it becomes active, the disease can be spread to others. If not properly treated, the disease, which most often affects the lungs, can be fatal.

"We have a plan to eliminate TB and we're not there yet," Frickey said. "It's the second largest killer in the world."

It's a killer that has not been commonly found in the United States since the 1950s and 1960s.

"It was felt to be extremely rare 20 years ago and that it would be irradiated by 2002. That's just not true in Fairfax County," said Dr. James Lamberti, a pulmonologist. "A lot of your younger doctors, depending on where they studied, have not seen cases of tuberculosis."

The surge in local cases can be attributed to the influx of foreign-born residents, said the experts.

"What we know is that in Northern Virginia, about 90 percent of the cases are foreign-born residents," Lamberti said.

In fact, trends show that nationally, about 60 percent of the people with active cases of tuberculosis are born outside of the U.S. Locally, it's 90 percent, said Koppaka.

"It's important for everybody to remember, not every person who is foreign-born has TB," Koppaka said. "People shouldn't be fearful of someone because there are foreign."

ONLY ABOUT 10 percent of those who are infected with the TB bacteria develop the disease. Symptoms include a cough that lasts more than two weeks, spitting up blood, weight loss, night sweats and chest pain.

The infection can be detected through a skin test, but the more serious disease requires X-rays.

"TB is different than most infections. It's a reactive infection which means as a youngster, someone could become infected and the body fights it off and the person doesn't even know they had it," Lamberti said. "When it reactivates, however, it can infect other people."

Lamberti said TB generally reactivates when conditions upset or weaken the immune system. The treatment consists of taking medications for up to six months. Lamberti said, because of the greater health risk to the community that by law, the treatment must be witnessed to ensure the patient is taking the medications.

TB is transmitted casually, meaning all that is required is sharing the air with someone who has the disease.

Koppaka said to safe guard against the disease, immigrants, refugees and other groups granted permanent residency visas in the U.S. are required to be tested before entering the country. However, those considered to be temporary, such as business people, students, temporary workers and tourists are not.